Hair Piece Order Form - Natural Hair Replacement System

Custom-made Hairpiece Order Form

Natural System

All information is strictly confidential. None of your information is given or sold to anyone else.

*	required fields

Name		*
Address 1		*
Address 2
City		*
State/Province		*
Zip Code		*
Country		*
Email		*
Phone Number
Quantity

Scalloped Front

Yes

Base Color	Black
Clear	Brown
Flesh	Light Reddish Brown
Pink	Yellow
Match color sample (send 2" x 2" color example)


free style	left part	right part	center part	real pompadour	Afro style


left crown	right crown	center crown	left comb over	right comb over

Hair	Hair Length
Fine human remy hair Human hair Synthetic hair	4" (10 cm)	5" (13 cm)	6" (15 cm)	7" (18 cm)
	Special Hair Length EXTRA CHARGE 8"-10" $20 \| 11"-12" $30 \| 13"-16" $45
Afro Length	(specify length)
Wave or Curl
	Permanent Treatment .... Wave or Curl stays in, will not wash out.
	Temporary Treatment .... Wave or Curl does not stay, washes out.
	No Treatment

Knotting Instructions
Natural frontal hairline Base covering hairline	Density Light (60%) Medium Light (80%) Medium (100%) Medium Heavy (115%) Heavy (150%)	Under Knot Front only Entire perimeter None
Natural part or crown Hidden part or crown	Bleached Knots Yes No	Baby Hair Yes No

Color	Front	Top	Crown	Temple	Side	Back
Additional Gray	%	%	%	%	%	%
Additional Highlight	%	%	%	%	%	%

Special Instructions

Send your hairpiece for duplication to:

Gent's Place
8345 NW 66th St. #5422
Miami, FL 33166-2626

Method of Payment

Credit Card (VISA, MasterCard, JCB, American Express, Discover/Nova)
Personal Check (To: S. K. International)
Bank Check/Money Order (To: S. K. International)
Bank Wire Transfer (SKI bank information will be sent to you.)

Press the "Continue" button below to send your order to the factory. We will contact you by email and confirm your information.

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